2017-11-07T08:26:52-06:00 2016-12-31 390758449 Wipfli LLP 3703 Oakwood Hills Pkwy/PO Box 690 Eau Claire WI 547020690 990 2016-01-01 390773970 LADD MEMORIAL HOSPITAL LADD 7152942111 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 Thomas Geskermann CEO 7152942111 2017-11-02 1 HOLLY POKRANDT CPA P00449155 7158323407 2017-10-16 216.54.158.12 2017-11-02 14:33:48 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6CEE02139A89791A6A472EC5DB80E53BD358F9D2 2016 2017-02-10 21:41:12Z Osceola Medical Center Thomas Geskermann 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 34838079 0 X www.myomc.org X 1947 WI SERVING AS THE CATALYST TO CREATE A HEALTHIER COMMUNITY. 9 9 295 41 2094087 -193219 198966 688488 33788749 34017832 75255 78128 44465 53631 34107435 34838079 0 0 0 0 13733430 14801176 0 0 187856 19146768 19433744 32880198 34234920 1227237 603159 43017446 43467486 21653451 21432894 21363995 22034592 X TO INSPIRE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH HOME-TOWN CUSTOMER SERVICE, QUALITY AND STRATEGIC PARTNERSHIPS. 0 0 30232970 31503648 During 2016, Ladd Memorial Hospital provided inpatient, outpatient, and clinical care services to the residents of the greater Osceola area, regardless of ability to pay. Inpatient services were provided to 687 patients and totaled 1,862 days of service. Inpatient services included general medicine, surgery, pediatric, obstetric, newborn and swingbed care. Outpatient services included 2,765 emergency room visits; 3,315 radiology procedures; 843 Oncology Visits and 458 surgeries, as well as 1,595 physical therapy visits, 2,612 anti-coagulation clinic visits, 3,870 Urgent care visits and various other hospital services. Clinical care services included 19,625 clinic visits, 3,647 nurse visits, totaling 23,272 visits. 30232970 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 34 0 295 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 WI MN X TOM GESKERMANN 7152942111 2600 65TH AVENUE OSCEOLA WI 54020 ANNE MARIE PUESHNER vice chairperson 1.00 X X 0 0 0 heidi conrad director 1.00 X 0 0 0 tom hauge dds director 1.00 X 0 0 0 Edward Mauch DO director 1.00 X 0 0 0 Al Hogen chairperson 1.00 X X 0 0 0 greg Isaacson secretary 1.00 X X 0 0 0 TIM SKIBA Director 1.00 X 0 0 0 TOM KLUGOW DIrector 1.00 X 0 0 0 Amanda Trembreull MD director 1.00 X 0 0 0 Tyler Schmidtz Director (NON-VOTING) 1.00 X 0 0 0 Rene Milner MD Chief Medical Officer 1.00 X 0 0 0 heather lundstrom CFO 40.00 X 135544 0 17873 tom geskermann ceo 40.00 X 191442 0 35359 linda k moore clinic director 40.00 X 113728 0 24022 Pamela Blomstrand Pharmacist 40.00 X 146585 0 26868 Rachel Johnson-himes Pharmacist 40.00 X 125870 0 15321 Amy Erickson Director of Outpatient Ser 40.00 X 116823 0 17251 Marybeth Gustafson Pharmacist 40.00 X 133044 0 21978 963036 0 158672 8 0 1 0 HEALTHPARTNERS GROUP HEALTH INC MAIL STOP 21109A ST PAUL MN 55164 PHYSICIANS 4817454 CENTRAL MINNESOTA DIAGNOSTIC INC PO BOX 158 MILACA MN 56353 DIAGNOSTIC IMAGING 850474 RIVER VALLEY ANESTHESIA INC PO BOX 118 NEW RICHMOND WI 54017 ANESTHESIOLOGY SERVICES 583280 MARSHFIELD LABS 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 LABORATORY SERVICES 461712 CPSI PO BOX 850309 MOBILE AL 36685 ELECTRONIC HEALTH RECORDS 232074 8 651051 9191 28246 688488 Net Patient Service Rev 621990 33160239 31066152 2094087 FITNESS CENTER 713940 437496 437496 GIFT SHOP 621990 50753 50753 369344 369344 34017832 65517 65517 53631 0 53631 53631 53631 12611 0 12611 12611 12611 34838079 31503648 2094087 551856 X 380218 380218 11600372 9274894 2177987 147491 394509 315423 74070 5016 2266102 2152267 104853 8982 159975 124623 33251 2101 9366 9366 58945 58945 8081996 7681224 391268 9504 51094 51094 759015 341619 405365 12031 12375 12375 1435293 1435293 60321 31977 26658 1686 1800831 1800831 38633 38633 Medical Supplies/Equipm 6131974 6131974 Provision for Bad Debt 627918 627918 Food Expense 156851 156851 Hospital assessment 93521 93521 115611 64555 50011 1045 34234920 30232970 3814094 187856 7220852 7886846 5780514 5949634 3399315 4156525 777170 841805 129034 112345 37734257 14955455 23805444 22778802 399991 401689 701308 701308 803818 638532 43017446 43467486 3043130 3729136 65000 40000 16730786 15810700 1763447 1623058 51088 230000 21653451 21432894 X 21363995 22034592 21363995 22034592 43017446 43467486 603159 67438 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 959 959 0 Part II-B, Line 1: Ladd Memorial Hospital pays annual association membership dues to the wisconsin hospital association (WHA). These dues are primarily for access to educational materials and staff training and development. The WHA has notified Ladd Memorial Hospital that $959 of the annual dues were used in conjunction with lobbying activities with the goal of improving the overall healthcare environment. 1547047 1547047 27037255 8318243 18719012 9092824 6637212 2455612 57131 57131 22778802 Amounts Payable to third-party reimbursement programs 230000 230000 1 1 1 X 1 X 1 1 0 1 1 171665 171665 0.00500 3680240 2358926 1321314 0.03860 3851905 2358926 1492979 0.04360 105832 11626 94206 0.00280 70107 70107 0.00200 7846233 5623739 2222494 0.06490 11023 11023 0.00030 8033195 5635365 2397830 0.07000 11885100 7994291 3890809 0.11360 2880 2880 0.00010 384 384 0.00000 3264 3264 0.00010 1 627918 156980 10096634 10158613 -61979 X 1 1 1 1 LADD MEMORIAL HOSPITAL DBA OSCEOLA MED 2600 65TH AVENUE OSCEOLA WI 54020 www.myomc.org 1021 X X X X Osceola Medical Center 1 0 0 1 X X X X X X X X 16 1 1 1 1 X http://www.myomc.org/about/community X https://www.healthypolkcounty.com/community-health-needs-assessment X 1 16 0 1 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X https://www.myomc.org/myomc/payment/financial-assistance X https://www.myomc.org/myomc/payment/financial-assistance X https://www.myomc.org/myomc/payment/financial-assistance X X X X X 1 X 0 X X X X 1 X X 0 0 Osceola Medical Center Part V, Section B, Line 5: The Community Health Needs Assessment (CHNA) sought input from persons who represent the broad interests of the community served including healthcare providers, community leaders, and the public. A county wide survey of the health of Polk County residents was made available at all of the local medical centers and the health department, as well as advertised in the local newspapers and posted on all four of the partners organization's websites (650 respondents).In addition to the aforementioned survey, four community forums were sponsored in Balsam Lake, St. Croix Falls, Amery and Osceola. The community members in attendance offered input and suggestions on the health focus areas. In addition, a partner meeting was held in April targeting key organizations and stakeholders as well as local health-related coalition representatives. At each of these venues, attendees had the opportunity to provide input on the top health focus areas.The final top health focus areas selected by participants in the CHNA process were:1. Mental Health2. Substance Abuse3. Access to Care4. Obesity Osceola Medical Center Part V, Section B, Line 6a: The CHNA was conducted and a community health improvement process ("CHIP") was developed in joint effort with the following other hospitals:1. Amery Regional Medical Center2. St. Croix Regional Medical Center Osceola Medical Center Part V, Section B, Line 6b: The CHNA was conducted and CHIP developed in joint effort with the Polk County Health Department. Osceola Medical Center Part V, Section B, Line 11: The hospital is addressing the most significant needs identified in its most recently conducted CHNA as follows:Mental Health - 1. The Hospital assisted the county Mental Health Task Force with updating its list of local mental health resources LIST and distributing it widely in the community. Polk County residents will now have knowledge of and easy access to an annually updated Mental Health Services Directory.2. An assessment, referral and follow up protocol was developed for the school system for students at high risk of suicide. The Hospital provided staff membership on the task force, and its foundation, the Osceola Community Health Foundation (OCHF), provided grant money. The hospital also funded a counselor in the Osceola School District. Through a grant by OCHF, the Healthy Beginnings project in the county offered student therapy services both onsite in the schools and at home visits.3. The Hospital participated in the county wide "Behind the Door" campaign that calls for mounting awareness posters with referral information on the backsides of public doors (i.e. bathrooms). This campaign promotes awareness of suicide as a preventable public health problem.4. All clinical providers at the Hospital provide screening for depression at all patient encounters.5. An awareness of the importance of protective behaviors to combat bullying provided through a Hospital provided counselor in the Osceola School District.In addition, the hospital offered mental health information as part of a free women's night health expo. The Mental Health Task Force secured an Otto Bremer Foundation grant to develop a depression screening program (to be implemented 2015-2016).Obesity - The Hospital and its community health partners addressed the obesity issue as follows:1. Pursued development of the best practice school wellness programs.2. Through OCHF, helped faciliate fundraising for a food and vegetable component to an existing "Back Pack" program in Osceola that provides supplemental food for free and reduced meals families for weekend use. Through the Hospital's fitness center, offered "Fit for Life" fitness weight loss classes, and youth programs that featured nutrition, fitness and wellness.3. The Hospital is promoting county wide recreational resources and clubs. The free, Jeff Meyer Public Fitness Trail continues to accommodate fitness and wellness needs in the community. Through OCHF, a grant was provided to the local "Grow Osceola" group to promote fitness through trail use in the Osceola area. A resource brochure detailing school obesity prevention programs was created and distributed.4. Through our fitness center, participated in a "Power Up" fitness and nutrition event in the Osceola School District to support implementation of best practice programs to increase physical activity at school and in the community.5. The Hospital is identifying, supporting, and pursuing policies that will help worksites strengthen their wellness programs. Through our Occupational Health Department, The Hospital provided health fairs and related opportunities to address worksite wellness programs. The Hospital worked with outside partners to promote weight loss and healthy living into worksites through Invogor-8, a wellness program series. A worksite Wellness Toolkit training schedule was developed for businesses in Polk County and implemented in 2015.6. All clinical providers at the Hospital provide screening to address weight and obesity issues at all patient encounters.7. Through our Occupational Health department, worked with one area industry to provide breastfeeding availability on site.8. The Hospital and OCHF fund and host Success by 6, a United Way program that provides physical, emotional and development growth to children under six and their parents. 9. Within its free monthly health seminar series, the Hospital offered the following seminars - nutritious freezer meal planning, lifelong weight loss, and managing diabetes through nutrition and exercise.10. Partnered with a local Trails Coalition to organize and sponsor free "Doc Walks" on area trails. Unhealthy Alcohol Use - The Hospital and its community health partners addressed unhealthy alcohol use through staff time, resources, and funding as follows:1. Community awareness around driving while intoxicated will be increased by a public awareness campaign. Data collected of operating while intoxicated on underage drinking citations gathered from Sheriff's Department and local municipalities will be used in this public awareness campaign.2. Initiatives to reduce underage alcohol use include awareness provided as part of Hospital provided counselor in the Osceola School District. 3. The Health Department secured a Parents Who Host grant. The goal of this campaign is to reduce access to alcohol by minors at a minimum of two community events.4. As part of the Hospital provided counselor services in the Osceola School District, increase access to counseling services for adolescents with underage drinking violations and adolescents whose parents are concerned about underage drinking behaviors.5. Increase community awareness around binge drinking through company health fairs.6. All clinical providers at the Hospital provide screening to address alcohol use at all patient encounters.In addition, a Polk County Guide to Alcohol Compliance Checks continues to be distributed, and a Community Health in Action Grant secured focusing on best practices for changing unhealthy alcohol practices in communities. Osceola Medical Center Part V, Section B, Line 13b: In a case by case review, Osceola Medical Center holds the right to make exceptions to the guidelines listed in the community care policy (such as but not limited to presumptive granting) when it is found to be in the best interest of the patient. 4 1 - Osceola Clinic 2600 65th Avenue Osceola WI 54020 Provider based clinic 2 - Clinic Pharmacy 2600 65th Avenue osceola WI 54020 retail pharmacy 3 - Scandia Clinic 21150 Ozark Court North Scandia MN 55073 Free Standing Clinic 4 - WIld River fitness center 2630 65th Avenue osceola WI 54020 Fitness Center Part I, Line 6a: The Community Benefit Report is available upon request. Part I, Line 7: The costing method used on Form 990 is based on a cost-to-charge ratio which is developed based on the hospital's total operating expenses less the provision for bad debts divided by gross patient service revenue. This cost-to-charge ratio is applied against various revenue and expense categories to compute the estimated community benefit expense under IRS costing methods for the Form 990. The cost of community health improvement, health professionals education, and in-kind contributions reflects the direct and indirect costs as determined by the hospital. Part I, Line 7g: The cost of subsidized health services is based on cost allocations from the medicare cost report. Services include nursery, massage therapy, occupational health, clinic services, emergency room, and physician services. Part II, Community Building Activities: While there is growing agreement in the United States about what constitutes a non-profit hospital's 'community benefit,' this is a work in progress. Our hospital provides significant charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit which is not quantified. Our hospital, like most rural hospitals, was created and is maintained in order to provide care locally-care that without our hospital, would not be available locally.Beyond inpatient hospitalizations, we provide local access to many health services including: Birthing Center, Diagnostics, Emergency Services & Urgent Care, Infusion Services, Inpatient Care, Laboratory Services, Occupational Health, Rehabilitation Services, Specialty Medicine, Sleep Center, Speech, and Surgical Services. Part III, Line 4: Accounts receivable and credit policy: In evaluating the collectability of accounts receivable, Osceola Medical Center analyzes past results and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. Specifically, for receivables associated with services provided to patients who have third-party coverage, Osceola Medical Center analyzes contractually due amounts and provides an allowance for doubtful accounts on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), Osceola Medical Center records a provision for bad debts in the period of service on the basis of their past experience, which indicates that many patients are unable to or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The audited financial statements do not include a separate footnote regarding bad debt expense. Part III, Line 8: Osceola Medical Center has been designated as a critical access hospital but did recognize a shortfall from the medicare program due to sequestration adjustments to amounts paid.The Cost-to-charge ratios used to calculate the cost of medicare services were taken from the medicare cost report.Whether there is a shortfall or surplus on services provided to medicare beneficiaries, these people, which are typically elderly or disabled members of the community, are an underserved population who experience issues with access to healthcare services. without tax-exempt hospitals providing medicare patient services, the centers for medicare and medicaid (cms) would bear the burden of directly providing services to the elderly and disabled members of the community. Part III, Line 9b: ONCE APPROVED FOR FINANCIAL ASSISTANCE, THAT FINANCIAL ASSISTANCE IS VALID FOR ONE YEAR FROM THE APPROVAL DATE WITH FOLLOW UP VERIFICATION COMPLETED AFTER 6 MONTHS. IT IS THE PATIENT'S RESPONSIBILITY TO NOTIFY OMC IMMEDIATELY SHOULD THERE BE ANY CHANGE IN THE DETERMINING FACTORS WITHIN THE APPROVED YEAR PERIOD. Part VI, Line 2: The Medical Center assesses the healthcare needs of the community by working with county and state offices, communicating with civic organizations, and interpreting feedback from one-on-one conversations with patients. In addition, a community health needs assessment (CHNA) is completed every three years. The CHNA sought input from diverse stakeholders, including healthcare providers, community leaders, and the public. The ultimate goal of the assessment is to identify health issues and develop strategies to address the community's health needs. This effort included a comprehensive review of health data, an analysis of real time body mass index data from local client patient electronic medical records and health and lifestyle data from community surveys. Part VI, Line 3: Osceola Medical Center has information regarding the charity care policy and other financial assistance options available:1. On their website2. Placed in mailings3. Pamphlets used by the hospital's providers that can be distributed4. A dedicated patient advocate position that works one on one with patients These resources are available to ensure that all patients fully understand all options that are available for assistance. Part VI, Line 4: Osceola Medical Center serves the city of Osceola Wisconsin and neighboring communities in western Wisconsin and Eastern Minnesota. The median income in the surrounding area is approximately $50,000 per year. Approximately 11% of the local population lives at or below the federal property guidelines and approximately 18% of Polk County's residents receive some type of assistance from the State of Wisconsin. Part VI, Line 5: A majority of Osceola Medical Center's governing body is comprised of persons who reside in the hospital's primary service area who are neither employees nor contractors of the hospital, nor family members thereof.Osceola Medical Center also promotes community health by providing free health seminars, free baby & me classes, and other classes for a fee such as athletic screenings and prediabetes classes. Osceola Medical Center is a non-profit organization, and therefore all earnings in excess of cost are used by the hospital to improve the healthcare of the people they serve through the purchase or upgrade of facilities and equipment, or the addition or expansion of needed services. Part VI, Line 7, Reports Filed With States WI X X X X X 0 0 0 0 0 0 0 0 0 heather lundstrom CFO 135544 0 0 0 0 0 7022 0 10851 0 153417 0 0 0 tom geskermann ceo 191442 0 0 0 0 0 8814 0 26545 0 226801 0 0 0 Pamela Blomstrand Pharmacist 146585 0 0 0 0 0 301 0 26567 0 173453 0 0 0 Marybeth Gustafson Pharmacist 133044 0 0 0 0 0 6950 0 15028 0 155022 0 0 0 A VILLAGE OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND 396006338 2007-06-13 8000000 REFINANCE EXISTING BONDS & CONSTRUCT NEW HOSPITAL BUILDING 0 0 0 B TOWN OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND 396006044 2007-06-28 7040000 CONSTRUCT NEW HOSPITAL BUILDING 0 0 0 C TOWN OF FARMINGTON HOSPITAL FACILITIES REVENUE BOND 390990620 2007-07-13 6040000 CONSTRUCT NEW HOSPITAL BUILDING 0 0 0 A 1782994 8000000 138545 4581314 3280141 2008 1 0 1 1 B 1577484 7040000 80850 6959150 2008 0 0 1 1 C 1677563 6040000 65800 5974200 2008 0 0 1 1 A 0 0 0 0 0.00390 0.00390 0 0 0 B 0 0 0 0 0.00390 0.00390 0 0 0 C 0 0 0 0 0.00390 0.00390 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 Schedule K, Part II, Line 11, Column A: The amount listed was used to refinance existing debt. Schedule K, Part IV, Line 2: There is no rebate because there are no proceeds available for investment. All proceeds have been used for capital expenditures. Form 990, Part VI, Section B, line 11b The completed form was reviewed and approved by the administrator and chief financial officer before the form was filed. The board of directors finance committee meeting and the full board of directors received a copy after the return was filed. Form 990, Part VI, Section B, line 12c Each key employee, director, and officer signs statement each year during their annual review. Periodic education is done through internal communication. Form 990, Part VI, Section B, line 15 In setting the compensation of the CEO and CFO, the executive committee shall comply with Ladd Memorial Hospital's conflict of interest policy and, without limiting that compliance, will: (A) Act only with the participation of executive committee members who do not have a conflict of interest concerning the matter, (B) will obtain and rely upon appropriate data as to comparability, and (C) will adequately and timely document the basis for its determination, concurrently with making that determination. Appropriate data as to comparability can include, but is not necessarily limited to: compensation levels paid by similarly situated organizations, both taxable and tax-exempt, for functionally comparable positions; the availability of similar services in the geographic area of the corporation; current compensation surveys compiled by independent firms; or actual written offers from similar institutions competing for the services of the same individual. Adequate and timely documentation will generally be minutes or other records of the executive committee meeting that state: the compensation and when it was approved; the executive committee members who were present and how each voted; the comparability data obtained and relied upon by the executive committee and a summary of how the data was obtained, and any action taken in specific compliance with the Medical Center's conflict of interest policy. If the executive committee approves a compensation package for the CEO or CFO that is higher or lower than the range of comparability data obtained, the basis for the determination outside the range must be recorded. Minutes or other records of the executive committee that document a decision on CEO or CFO compensation must be prepared before the later of the next meeting of the executive committee or 60 days after the decision, and must be reviewed and approved by the executive committee within a reasonable period thereafter. Form 990, Part VI, Section C, line 19 LADD MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part IX, line 11g Physician Services: Program service expenses 4,846,957. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,846,957. Anesthesia Services: Program service expenses 528,771. Management and general expenses 0. Fundraising expenses 0. Total expenses 528,771. Lab Services: Program service expenses 476,560. Management and general expenses 0. Fundraising expenses 0. Total expenses 476,560. Radiology Services: Program service expenses 973,693. Management and general expenses 0. Fundraising expenses 0. Total expenses 973,693. Other purchased services: Program service expenses 855,243. Management and general expenses 0. Fundraising expenses 9,504. Total expenses 864,747. Administrative Services: Program service expenses 0. Management and general expenses 194,014. Fundraising expenses 0. Total expenses 194,014. Data Processing: Program service expenses 0. Management and general expenses 197,254. Fundraising expenses 0. Total expenses 197,254. FORM 990, PART XII, LINE 2C: OVERSIGHT OF AUDIT THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT AUDITOR AND MANAGEMENT OVERSEES THE AUDIT PROCESS. This process has not changed from the prior year. OSCEOLA COMMUNITY HEALTH FOUNDATION INC 2600 65TH AVENUE OSCEOLA WI 54020 392029106 FOUNDATION WI 501(c)(3) Line 12a, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0